Posttraumatic stress disorder in critical illness survivors: A metaanalysis

Ann M. Parker, Thiti Sricharoenchai, Sandeep Raparla, Kyle W. Schneck, O. Joseph Bienvenu, Dale M. Needham

Research output: Contribution to journalReview articlepeer-review

Abstract

Objective: To conduct a systematic review and metaanalysis of the prevalence, risk factors, and prevention/treatment strategies for posttraumatic stress disorder symptoms in critical illness survivors. Data Sources: PubMed, Embase, CINAHL, PsycINFO, and Cochrane Library from inception through March 5, 2014. Study Selection: Eligible studies met the following criteria: 1) adult general/nonspecialty ICU, 2) validated posttraumatic stress disorder instrument greater than or equal to 1 month post-ICU, and 3) sample size greater than or equal to 10 patients. Data Extraction: Duplicate independent review and data abstraction from all eligible titles/abstracts/full-text articles. Data Synthesis: The search identified 2,817 titles/abstracts, with 40 eligible articles on 36 unique cohorts (n = 4,260 patients). The Impact of Event Scale was the most common posttraumatic stress disorder instrument. Between 1 and 6 months post-ICU (six studies; n = 456), the pooled mean (95% CI) Impact of Event Scale score was 20 (17-24), and the pooled prevalences of clinically important posttraumatic stress disorder symptoms (95% CI) were 25% (18-34%) and 44% (36-52%) using Impact of Event Scale thresholds greater than or equal to 35 and greater than or equal to 20, respectively. Between 7 and 12 months post-ICU (five studies; n = 698), the pooled mean Impact of Event Scale score was 17 (9-24), and pooled prevalences of posttraumatic stress disorder symptoms were 17% (10-26%) and 34% (22-50%), respectively. ICU risk factors for posttraumatic stress disorder symptoms included benzodiazepine administration and post-ICU memories of frightening ICU experiences. Posttraumatic stress disorder symptoms were associated with worse quality of life. In European-based studies: 1) an ICU diary was associated with a significant reduction in posttraumatic stress disorder symptoms, 2) a self-help rehabilitation manual was associated with significant posttraumatic stress disorder symptom reduction at 2 months, but not 6 months; and 3) a nurse-led ICU follow-up clinic did not reduce posttraumatic stress disorder symptoms. Conclusions: Clinically important posttraumatic stress disorder symptoms occurred in one fifth of critical illness survivors at 1-year follow-up, with higher prevalence in those who had comorbid psychopathology, received benzodiazepines, and had early memories of frightening ICU experiences. In European studies, ICU diaries reduced posttraumatic stress disorder symptoms.

Original languageEnglish (US)
Pages (from-to)1121-1129
Number of pages9
JournalCritical care medicine
Volume43
Issue number5
DOIs
StatePublished - May 20 2015

Keywords

  • critical care
  • critical illness
  • metaanalysis
  • posttraumatic stress disorders
  • review

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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